Network of healthcare organizations, together with data partners in Brazil, South Korea, and Japan, to bring clinical facts on more than 250 million patients around the world. Federated model so users of this data are ensured new patients, observations, and results every day, all harmonized to standard terminology like ICD-10 and LOINC without any data wrangling required at the point of care. The raw data is not available to authors of papers and papers in medicine are being retracted.

ObjectiveTo explore the associations between the use of immune checkpoint inhibitors (ICIs) and the risk of developing uveitis among cancer patients.MethodsCancer patients who received ICI therapy and a comparison group of cancer patients who did not receive ICI therapy were retrospectively recruited from the TriNetX electronic heath-record registry. The outcome of interest was the development of new-onset uveitis. Propensity score matching based on a 1:1 ratio was conducted in order to reduce bias. Multi-variate cox proportional hazard models and Kaplan Meier method were also utilized to assess for the risk of uveitis among cancer patients who received ICI therapy.Results71931 cancer patients (54.7% male; 76.5% white; mean age at index 63.6 ± 12.2 years) who received ICI treatment (ICI group) and 71931 cancer patients (54.7% male; 77% white; mean age at index 63.5 ± 12.4 years) who never received ICI (comparison group) were recruited. Associated Kaplan-Meier curves showed significantly increased uveitis risk among the ICI group for all follow-up years (p

TriNetX outputs from updated searches undertaken on 24/10/2024 after peer review.

This is the Mendeley Supplementary File (including eMethods, Supplementary Tables and Supplementary Figures) of the study entitled "Human Papillomavirus Infection Increases Risk of New-Onset Prurigo Nodularis: A Multi-Center Retrospective Cohort Study Using Global and US Electronic Medical Records of TriNetX network" by Shuo-Yan Gau, Shao-Wei Lo, Yung-Fang Tu, Wen-Chieh Liao, Yu-Jung Su, Hui-Chin Chang, Torsten Zuberbier, Martin Metz and Shiu-Jau Chen for publication in the Journal of the American Academy of Dermatology.

The risk of active tuberculosis diagnosis is lower with interleukin (IL)-17, IL-23, IL-12/23, and Janus kinase inhibitors than with Tumor Necrosis Factor-α inhibitors, but is elevated compared with the population risk.

Cohorts included patients treated for at least one year with TNF-α inhibitors, IL-17 inhibitors, IL-23 inhibitors, ustekinumab, dupilumab, systemic Janus kinase (JAK) inhibitors, or cyclosporine for any indication (Supplemental Table 1). Minimum exposure time was identified by at least one additional prescription within one to two years of the initial prescription. TB (International Classification of Diseases [ICD]-10 codes A15–A19) diagnosis within one year of initial prescription was the primary outcome. Exclusion criteria were concurrent prescription of another study drug within two years and known latent TB infection (Z22.7), due to difficulty identifying treatment status. Yearly TB incidence was calculated. Unadjusted (due to query limitations of the built-in TriNetX analysis platform) logistic regressions compared drug-associated TB risk with baseline TB risk (of patients never taking any included drugs). Multivariable Cox proportional hazards models assessed the one-year TB risk of studied drugs compared to TNF-α inhibitors (Table 2) while adjusting for known TB risk factors (Supplemental Table 2).

All drug classes except dupilumab conferred a higher unadjusted rate of TB compared to the baseline population risk. All drug classes had a lower adjusted risk of TB compared with TNF-α inhibitors. Fully adjusted regressions identified diabetes, viral hepatitis, age, and male sex as additional risk factors (Supplemental Tables 3-8).

ObjectiveTo compare the effects of tofacitinib and adalimumab on the risk of adverse lipidaemia outcomes in patients with newly diagnosed rheumatoid arthritis (RA).MethodsData of adult patients newly diagnosed with RA who were treated with tofacitinib or adalimumab at least twice during a 3-year period from 1 January 2018 to 31 December 2020, were enrolled in the TriNetX US Collaborative Network. Patient demographics, comorbidities, medications, and laboratory data were matched by propensity score at baseline. Outcome measurements include incidental risk of dyslipidemia, major adverse cardiac events (MACE) and all-cause mortality.ResultsA total of 7,580 newly diagnosed patients with RA (1998 receiving tofacitinib, 5,582 receiving adalimumab) were screened. After propensity score matching, the risk of dyslipidaemia outcomes were higher in the tofacitinib cohort, compared with adalimumab cohort (hazard ratio [HR] with 95% confidence interval [CI], 1.250 [1.076–1.453]). However, there is no statistically significant differences between two cohorts on MACE (HR, 0.995 [0.760–1.303]) and all-cause mortality (HR, 1.402 [0.887–2.215]).ConclusionTofacitinib use in patients with RA may increase the risk of dyslipidaemia to some extent compared to adalimumab. However, there is no differences on MACE and all-cause mortality.

BackgroundADHD is a condition with extensively researched increased risks of psychiatric disorders, traumatic injury, impulsivity, and delayed response times.ObjectivesTo analyze the incidences of fractures in patients with ADHD on various medication regimens.MethodsUsing the TriNetX database, we created seven patient cohorts, all of age under 25, based on medication types commonly used for ADHD. The cohorts we created were: no medication use, exclusive use of a -phenidate class stimulant, exclusive use of an amphetamine class stimulant, nonexclusive use of formations of either stimulant, exclusive use of non-stimulant medications approved for ADHD, nonexclusive use, and no medications. We then examined rates while controlling for age, sex, race, and ethnicity.ResultsThe comparison of ADHD to neurotypical individuals revealed an increased risk for all fracture types. For the controlled analysis, all but one cohort had significant differences in each fracture type compared to the baseline cohort of ADHD patients without any medication use. Patients in the “phenidate” cohort had an insignificant difference in risk of lower limb fractures. Patients in the “any medication,” “-etamine,” “stimulant,” and “not ADHD” groups all had significant decreased risks for all fracture types, with confidence intervals often overlapping between treatment modalities.ConclusionsAs patients experiment with different medication regimens, providers should be aware of the difference in risk of fracture by medication type. Our results highlight the need for continued research to better discern appropriate medication regimens with the goal of improving overall risk reduction and producing better outcomes for individuals with ADHD.

Analysis was performed after propensity score matching for age and gender at the index event.

Studies conflict on the significance of burn-induced coagulopathy. We posit that burn-induced coagulopathy is associated with injury severity in burns. Our purpose was to characterize coagulopathy profiles in burns and determine relationships between % total burn surface area (TBSA) burned and coagulopathy using the International Normalized Ratio (INR). Burned patients with INR values were identified in the TriNetX database and analyzed by %TBSA burned. Patients with history of transfusions, chronic hepatic failure, and those on anticoagulant medications were excluded. Interquartile ranges for INR in the burned study population were 1.2 (1.0–1.4). An INR of ≥ 1.5 was used to represent those with burn-induced coagulopathy as it fell outside the 3rd quartile. The population was stratified into subgroups using INR levels

Diabetes mellitus (DM) increases the incidence of age-related cataracts. Currently, no medication is approved or known to delay clinical cataract progression. Using a novel approach based on AI, we searched for drugs with potential cataract surgery-suppressing effects. We developed a drug discovery strategy that combines AI-based potential candidate prediction among 2650 Food and Drug Administration (FDA)-approved drugs with clinical corroboration leveraging multicenter electronic health records (EHRs) of approximately 800,000 cataract patients from the TriNetX platform. Among the top-10 AI-predicted repurposed candidate drugs, we identified three DM diagnostic ICD code groups, such as cataract patients with type 1 diabetes mellitus (T1DM), type 2 diabetes mellitus (T2DM), or hyperglycemia, and conducted retrospective cohort analyses to evaluate the efficacy of these candidate drugs in reducing the risk of cataract extraction. Aspirin, melatonin, and ibuprofen were associated with a reduced 5-, 10-, and 20-year cataract extraction risk in all types of diabetes. Acetylcysteine was associated with a reduced 5-, 10-, and 20-year cataract extraction risk in T2DM and hyperglycemia but not in T1DM patient groups. The suppressive effects of aspirin, acetylcysteine, and ibuprofen waned over time, while those of melatonin became stronger in both genders. Thus, the four repositioned drugs have the potential to delay cataract progression in both genders. All four drugs share the ability to directly or indirectly inhibit cyclooxygenase-2 (COX-2), an enzyme that is increased by multiple cataractogenic stimuli.

This retrospective cohort study utilized electronic health records from the TriNetX database. A total of 502 NHL patients were included, categorized into CAR-T R+ (receiving CAR-T and radiotherapy) and CAR-T R- (receiving CAR-T and chemotherapy only) groups, balanced through propensity score matching. The primary outcome was four-year mortality risk. Secondary outcomes included emergency visits, organ failure, sepsis, cardiovascular events, inflammation over four years, and acute reactions (Cytokine Release Syndrome (CRS) and Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS)) measured over one month.

IntroductionWe conducted an extensive, sex-oriented real-world data analysis to explore the impact and safety of non-steroidal anti-inflammatory drugs (NSAIDs) and selective COX-2 inhibitors (coxibs) on cancer treatment outcomes. This is particularly relevant given the role of the COX-2/PGE2 pathway in tumor cell resistance to chemotherapy and radiotherapy.MethodsThe study applied a retrospective cohort design utilizing the TriNetX research database consisting of patients receiving cancer treatment in 2008-2022. The treated cohorts included patients who were prescribed with coxibs, aspirin or ibuprofen, while individuals in the control cohort did not receive these medicines during their cancer treatment. A 1:1 propensity score matching technique was used to balance the baseline characteristics in the treated and control cohorts. Then, Cox proportional hazards regression and logistic regression were applied to assess the mortality and morbidity risks among patient cohorts in a 5-year follow-up period.ResultsUse of coxibs (HR, 0.825; 95% CI 0.792-0.859 in females and HR, 0.884; 95% CI 0.848-0.921 in males) and ibuprofen (HR, 0.924; 95% CI 0.903-0.945 in females and HR, 0.940; 95% CI 0.917-0.963 in males) were associated with improved survival. Female cancer patients receiving aspirin presented increased mortality (HR, 1.078; 95% CI 1.060-1.097), while male cancer patients also had improved survival when receiving aspirin (HR, 0.966; 95% CI 0.951-0.980). Cancer subtype specific analysis suggests coxibs and ibuprofen correlated with survival, though ibuprofen and aspirin increased emergency department visits’ risk. Secondary analyses, despite limited by small cohort sizes, suggest that COX inhibition post-cancer diagnosis may benefit patients with specific cancer subtypes.DiscussionSelective COX-2 inhibition significantly reduced mortality and emergency department visit rates. Further clinical trials are needed to determine the optimal conditions for indication of coxibs as anti-inflammatory adjuvants in cancer treatment.

Introduction Limited evidence guides clinicians regarding the agent selection between bumetanide and torsemide in patients with heart failure (HF). The present study aimed to compare the efficacy and safety profile of bumetanide and torsemide in patients with HF.

Methods Patients aged > 18 years with HF with reduced ejection fraction (HFrEF) receiving either bumetanide or torsemide were included from the TriNetX research network. Patients with end-stage renal disease were excluded from this study. The primary outcome was all-cause mortality, and secondary outcomes included all-cause hospitalization or emergency department visits, acute kidney injury, or hypokalemia over one- year follow-up period.

Results After propensity score matching, 16,277 patients in each group were included. The use of bumetanide was significantly associated with a higher risk of all-cause mortality (19.7 vs. 16.0 %; OR 1.28; 95% CI [1,21, 1.36]) compared to the torsemide group. The use of bumetanide was also significantly associated with higher risks of all-cause hospitalization or emergency department visits (53.3 vs. 48.3%; OR 1.22 95% CI [1.17, 1.28]), acute kidney injury (33.4 vs. 27.1 %; OR 1.35; 95% CI [1.29, 1.42]), and hypokalemia (16.6 vs. 13.7%; OR 1.21, 95% CI [1.17, 1.33]) compared to the torsemide group.

Conclusion The use of torsemide in patients with HFrEF is associated with lower risks of clinical outcomes than bumetanide. Further investigation of this association is warranted in clinical trials.

Introduction: Patients with migraine may be more susceptible to benign paroxysmal positional vertigo (BPPV) than the general population. Although the underlying pathophysiology remains uncertain, it has been postulated that recurrent vasospasms associated with migraine attacks may cause inner ear ischemia and changes in endolymph pressure. Currently, there are no specific recommendations for preventing BPPV in this vulnerable patient population. Among commonly used migraine abortive drugs, triptans, which are selective serotonin agonists, are known to be vasoconstrictive, whereas calcitonin gene-related peptide (CGRP) antagonists are not. This population-based study uses a federated electronic medical record (EMR) database to characterize the prevalence of BPPV among migraine patients and its relevance to their choice of abortive drug.

Methods: In this case-control study, EMR data from the TriNetX US Collaborative Network was queried for subjects who were seen at a participating healthcare organization for a vestibular disorder (ICD10: H81) between 2019 and 2024. Subjects must also have a concomitant, pre-existing diagnosis of migraine (G43). These patients were stratified by age (18-44, 45-64, 65+ years) and sex. The resulting cohorts were then divided into those with and without a BPPV diagnosis (H81.1). Patients with prior documented head trauma (S02, S06, S09), middle or inner ear surgery, or vitamin D deficiency (E55) were excluded. The prevalence of pre-existing triptan and CGRP antagonist use of each BPPV cohort was compared against the non-BPPV cohort of the same age and sex using Chi-square analysis.

Results: As expected, the female subject population had significantly higher prevalence of migraine (17.06% vs 7.26%, p

There is limited data comparing Azacitidine plus Venetoclax (HMA&Ven) versus traditional intensive chemotherapy with Cytarabine plus Anthracycline (IC) in older patients. We conducted a propensity score-matched cohort study using the TriNetX database to compare the mortality and safety outcomes in this patient population. The analysis resulted in 370 patients in each group. Compared to IC, HMA&Ven had a similar rate of all-cause mortality in 1 year follow-up (HR: 1.16 [95% CI: 0.93-1.44], p-value = 0.186). However, HMA&Ven had fewer neutropenia (HR: 0.72 [95% CI: 0.60-0.87], p-value < 0.001) and sepsis (HR: 0.72 [95% CI: 0.56-0.92], p-value = 0.009). These data suggest that these patients receiving HMA&Ven have fewer adverse events without a difference in survival compared to IC.

Abstract Introduction While an association between hidradenitis suppurativa (HS) and inflammatory arthritis has been reported in clinical studies, the potential link between HS and gout remains uncertain. As HS and gout share common immunological pathways, we conducted a retrospective cohort study to determine whether HS patients are at an increased risk of developing gout in the future.

Methods This retrospective multicenter cohort study obtained information through the US collaborative network, a subset of the TriNetX research network. Patients diagnosed with HS between January 01, 2005, and December 31, 2017, were recruited, and a 1:1 propensity score matching was conducted to identify appropriate controls. The hazard ratio for the new-onset of gout in HS patients was subsequently calculated.

Results Compared to individuals without HS, those with HS were associated with a 1.39-fold higher risk (95% CI, 1.20, 1.62) of developing new-onset gout within five years after the index date. This association remained significant in shorter follow-up times and sensitivity analyses utilizing different matching models. For both male and female HS patients, the risk of developing new-onset gout within 5 years after the index date was statistically significant, with respective hazard ratios of 1.61 (95% CI, 1.28,2.02) for males and 1.41 (95% CI, 1.11,1.78) for females.

Conclusion HS patients are at a high risk of developing gout within five years after an HS diagnosis while comparing with non-HS controls.